Ownership Submission
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FORM 4
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Check this box if no longer subject to Section 16, Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL
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OMB Number:3235-0287Expires:January 31, 2005Estimated average burden hours per response...0.5
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1. Name and Address of Reporting Person *
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AINOS INC
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2. Issuer Name and Ticker or Trading Symbol
Ainos, Inc. [AIMD]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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_____ Director
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_____ 10% Owner
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_____ Officer (give title below)
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_____ Other (specify below)
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(Last)
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(First)
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(Middle)
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14F., NO. 61, SEC. 4 , NEW TAIPEI BOULEVARD, XINZHUANG DISTRICT
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3. Date of Earliest Transaction (Month/Day/Year)
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(Street)
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NEW TAIPEI CITY
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F5
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242
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4. If Amendment, Date Original Filed(Month/Day/Year)
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6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
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2. Transaction Date (Month/Day/Year)
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2A. Deemed Execution Date, if any (Month/Day/Year)
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3. Transaction Code
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4. Securities Acquired (A) or Disposed of (D)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
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6. Ownership Form: Direct (D) or Indirect (I)
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7. Nature of Indirect Beneficial Ownership
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
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8. Price of Derivative Security
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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11. Nature of Indirect Beneficial Ownership
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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AINOS INC
14F., NO. 61, SEC. 4
NEW TAIPEI BOULEVARD, XINZHUANG DISTRICT
NEW TAIPEI CITY, F5242
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Signatures
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/s/ John Junyong Lee POA for Chun-Hsien Tsai, Chief Executive Officer
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2022-08-11
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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(1)
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Prior to the Reverse Split discussed herein the Reporting Person beneficially owned 69,970,571 common stock of the Issuer and after the Reverse Split, and prior to the present issuances, 4,664,705 common stock. The amounts of securities beneficially owned in column 5 of this report is calculated from a post-split baseline of 4,664,705.
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(2)
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Reference is made to that certain non-interest bearing Convertible Note in the principal amount of $26,000,000 issued to the Reporting Person as consideration under an Asset Purchase Agreement with the Issuer ("APA Note"). The APA Note is payable by January 30, 2027 unless converted immediately prior to the closing of a public offering and listing on a U.S. stock exchange at 80% of the initial public offering price ("Offering"). On 08/11/22, the Company completed a public offering at a $4.25 per unit price ("Offering") and a 15-for-1 reverse stock split on 08/08/22 ("Reverse Split"). Transaction reflects an acquisition price of $3.40 per share (80% of the Offering) and the issued shares give effect to the Reverse Split.
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(3)
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Reference is made to that certain Convertible Note in the principal amount of $3,000,000 bearing 1.85% interest per annum payable on February 28, 2023 and issued to the Reporting Person as consideration for working capital advances made to the Issuer ("Capital Note"). As of the conversion date, the Capital Note accrued $42,959 in interest and was converted at a $0.20 conversion rate pursuant to the Capital Note. The transaction gives effect to the Reverse Split noted in Footnote 1 above.
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